Did You Know? Smoking Prevalence Differs by Marital Status and Race/Ethnicity

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It is unclear whether health risk behaviors differ by nuanced marital statuses and race/ethnicity. A recently published study examined the association between detailed marital status and current cigarette smoking among U.S. adults by race/ethnicity. Data were from four Health Information National Trends (HINTS) study cycles collected in 2011-2017 with a nationally representative sample of adults 30 years and older (n = 11,889).

 

Findings included:

·         Adults who had the highest prevalence of cigarette smoking were non-Hispanic Black cohabiters (36%), separated non-Hispanic White adults (35%), and single/never married Hispanic adults (28%).

·         Widowed adults had lower cigarette smoking prevalence than those who were divorced or separated across races/ethnicities.  

 

Source: Ramsey et al. (2019). Association between marital status and cigarette smoking: Variation by race and ethnicity. Preventive Medicine, Feb;119:48-51. doi: 10.1016/j.ypmed.2018.12.010. Epub 2018 Dec 18.

Study Examines why Bisexual Young Adults Use Tobacco at Higher Rates

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Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. A newly published study examined everyday smoking contexts and practices of bisexual individuals. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer.

 

Findings included:

·         Survey smoking patterns and situational predictors were similar to other young adults’.

·         However, interviews revealed unique roles of tobacco use in participants’ navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management.

 

Source: McQuoid et al (2019). Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults. Health & Place, Jan 10. pii: S1353-8292(18)30669-5. doi: 10.1016/j.healthplace.2018.12.010. [Epub ahead of print]

Did You Know? Sexual Minority Individuals More Likely to Have Severe Tobacco Use Disorder

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Sexual minority individuals have heightened risk for substance use; however, previous studies have not assessed severity of alcohol use disorders (AUDs), tobacco use disorders (TUDs), and drug use disorders (DUDs) among lesbian/gay and bisexual individuals and those “not sure” of their sexual identity compared with heterosexual individuals. A newly published study examined how three dimensions of sexual orientation (identity, attraction, and behavior) relate to severity of AUD, TUD, and DUD. This study used cross-sectional national data (N = 36,309) from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

 

Findings included:

·         Sexual minority respondents had higher odds of severe AUD or TUD than heterosexual respondents.

·         Those “not sure” of their sexual identity had higher odds of severe AUD, TUD, and DUD than heterosexual respondents.

 

The researchers concluded that bisexual and “not sure” U.S. adults are more likely to have a severe AUD and TUD. They also demonstrate the importance of treatment strategies that address sexual minority-specific risks, particularly for bisexual individuals and those “not sure” of their sexual identity.

 

Source: Boyd et al. (2019). Severity of Alcohol, Tobacco, and Drug Use Disorders Among Sexual Minority Individuals and Their “Not Sure” Counterparts. LGBT Health, Jan;6(1):15-22. doi: 10.1089/lgbt.2018.0122. Epub 2019 Jan 14.

Did You Know? Tobacco Tax Policy Alone May Not Be Enough To Increase Cessation Among African Americans

MENTHOL-CIGARETTES

A newly published study examined the effects of cigarette price on intention to quit, quit attempts, and successful cessation among African American smokers in the U.S. and explored whether price effects differed by income level and menthol use status. Researchers analyzed cross-sectional data from 2006-2007 and 2010-2011 Tobacco Use Supplements to the Current Population Survey from 4,213 African American recent active smokers.

Findings included:

·         There was no indication that price was associated with quit attempts or successful cessation, but price was positively associated with increased odds of intending to quit among African American smokers.

·         In contrast, prices were positively associated with intention to quit and quit attempts for White smokers.

·         The association between price and intention to quit was significantly positive for African American low-income and menthol smokers but was not statistically significant for African American high-income and non-menthol smokers.

·         There was no evidence of a price effect on quit attempts and successful cessation for each subgroup of African Americans.

The researchers concluded that tobacco tax policy alone may not be enough to increase quit attempts or successful cessation among African Americans. Community-based cessation programs tailored towards African American smokers, especially low-income menthol smokers, are needed.

Source: Keeler, Max, Yerger, Yao, Wang, Ong & Sung (2018). Effects of cigarette prices on intention to quit, quit attempts, and successful cessation among African American smokers. Nicotine & Tobacco Research, Jul 18, [Epub ahead of print].

Did You Know? California has Reduced Smoking Faster than the Rest of the US

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Three cigarette smoking behaviors influence lung cancer rates: how many people start, the amount they smoke, and the age they quit. California has reduced smoking faster than the rest of the US and trends in these 3 smoking behaviors should inform lung cancer trends. A newly published study examined trends in smoking behavior (initiation, intensity, and quitting) in California and the rest of US by regression models using the 1974-2014 National Health Interview Surveys (n=962,174).

 

Findings included:

·                     Among those aged 18- 35 years, California had much larger declines than the rest of the US in smoking initiation and intensity, and increased quitting.

·                     In 2012-14, among this age group, only 19% had ever smoked; smokers consumed only 6.3 cigarettes/day; and 46% of ever-smokers had quit by age 35.

·                     Each of these metrics was at least 24% better than in the rest of the US.

·                     There was no marked California effect on quitting or intensity among seniors. From 1986-2013, annual lung cancer mortality decreased more rapidly in California and by 2013 was 28% lower than in the rest of the US.

·                     California’s tobacco control efforts were associated with a major reduction in cigarette smoking among those under age 35 years.

 

The researchers concluded that these changes will further widen the lung cancer gap that already exists between California and the rest of the US.

 

Source: Pierce et al. (2018). Trends in lung cancer and cigarette smoking: California compared to the rest of the United States. Cancer Prevention Research, Oct 10. pii: canprevres.0341.2018. doi: 10.1158/1940-6207.CAPR-18-0341. [Epub ahead of print]

A Study Examines Perceived Positive And Negative Traits Of Adolescent E-Cigarette Users

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A newly published study examined the relationship between adolescents’ positive opinions of e-cigarette users and willingness to use e-cigarettes. Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015-2016.
Findings included:
  • The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users.
  • Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users.
  • Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users.
  • Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users.
  • Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users.
Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents’ negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.
Source: McKelvey et al. (2018). Adolescents have unfavorable opinions of adolescents who use e-cigarettes. PloS One, Nov 7;13(11):e0206352. doi: 10.1371/journal.pone.0206352. eCollection 2018.
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Top Reason for E-Cigarette Use Among Young Adults: “They come in flavors I like”
A newly published study examined whether strong local policies may reduce e-cigarette initiation rates by influencing the appeal of these products. Online questionnaires were completed by Southern California Children’s Health Study participants in 2015-2016 (mean age?=?18.9?years).

Findings included:

  • The top reason for e-cigarette use was “They come in flavors I like” (57%).
  • Using e-cigarettes to quit smoking was uncommon (13%).
  • Participants in jurisdictions with weaker tobacco retail licensing ordinances were more likely to report use of e-cigarettes because they are less harmful than cigarettes (50% vs. 36%), more acceptable to non-tobacco users (38% vs. 25%), and because they can use e-cigarettes in places where smoking is prohibited (31% vs. 18%).
The study authors recommend targeted policy that conveys the adverse impact of e-cigarettes, and restricts use in public places may reduce e-cigarette use among adolescents and young adults.
Source: Hong et al. (2018). The impact of local regulation on reasons for electronic cigarette use among Southern California young adults. Addictive Behaviors, Nov 16. pii: S0306-4603(18)31329-7. doi: 10.1016/j.addbeh.2018.11.020. [Epub ahead of print]

Low-Income Medicaid Beneficiaries Appreciate Physicians Giving Advice About Cessation

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Smoking is highly prevalent among low-income Medicaid beneficiaries and tobacco-cessation benefits are generally available. A newly published study examined the extent to which physicians provide advice to Medicaid patients about quitting. Data from the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Health Plans survey were merged with state Medicaid policy variables and analyzed.

 

Findings included:

·                  Almost one third (29%) of adult Medicaid beneficiaries smoke.

·                  Almost four fifths of smokers with a personal doctor (77%) say their doctor at least sometimes advised quitting and almost half of smokers discussed cessation medications (48%), or another strategy, such as counseling (42%).

·                  Smokers’ ratings of satisfaction with their physicians and their health plans rose as the frequency of smoking recommendations increased.

·                  Those in Medicaid managed care plans smoked more, but received less advice about cessation medications than those in fee-for-service care.

 

The researchers concluded that findings indicate that patients value prevention-oriented advice and give better ratings to physicians and health plans that offer more support and advice about cessation.

 

Source: Holla et al. (2018). Physicians’ Recommendations to Medicaid Patients About Tobacco Cessation. American Journal of Preventive Medicine, Oct 18. pii: S0749-3797(18)32126-3. doi: 10.1016/j.amepre.2018.07.013. [Epub ahead of print]

Our Tailored Assistance Trainers

 

A major feature of The LOOP is the provision of tailored assistance responsive to grantees’ requests, enabling them to implement more effectively their local tobacco control interventions and initiatives. This is a free service provided to statewide CTCP grantees. Subject matter experts have been identified and recruited to provide trainings and tailored assistance that cover a range of tobacco control topics, as well as other areas pertinent to reaching and serving California’s diverse populations.
 
You can currently make a request for tailored assistance by contacting us at theloop@ucsf.edu. This is a partial list of our tailored assistance trainers and their expertise.

Tobacco Advertising                      American Indian Casinos                            Advertising

Advocacy                                         Educational Materials Development         Evaluation

Community Organizing                Housing and Urban Development             Budget/Fiscal

Faith-Based Organizations           Outdoor Dining, Beaches, Parks                Coalition Build.

Grant Writing                                 Smokeless Tobacco/Cigars                           Fundraising

Health Disparities                          Health Policy Development                        Legal Issues

Leadership Development             Multi-Cultural Issues                                    Social Media

Multi-Unit Housing                        Social Marketing Campaigns                      Tobacco Litter

Research                                          Social Media                                                   Stake Act

Youth Coalition                               Tobacco Control Funding                            Harm Reduction

Combustible and Electronic Tobacco Use Frequently Featured in Popular Hip-Hop Music Videos

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A newly published study assessed the prevalence of the appearance and use of combustible and electronic tobacco and marijuana products, including brand placement, in leading hip-hop songs.

Analysis of top 50 songs from 2013 to 2017 of Billboard magazine’s weekly Hot R&B/Hip-Hop Songs with videos that included the appearance or use of combustible tobacco and marijuana products (manufactured cigarettes, cigars, hookah or waterpipe, pipe, hand-rolled tobacco and marijuana products, marijuana buds); appearance of exhaled smoke or vapor without an identifiable source product; appearance or use of electronic tobacco and marijuana products (eg, electronic cigarettes); tobacco or marijuana brand placement; appearance or use of combustible and electronic tobacco and marijuana by main or featured artist. Data were collected from December 6, 2017, to June 4, 2018.

 

Findings included:

·               The proportion of leading hip-hop videos containing combustible use, electronic use, or smoke or vapor ranged from 40.2% (76 of 189) in 2015, to 50.7% (102 of 201) in 2016.

·               For each year, the leading category of combustible use was hand-rolled products.

·               The appearance of branded products increased from 0% in 2013 (0 of 82) to 9.9% in 2017 (10 of 101) for combustible products, and from 25.0% in 2013 (3 of 12) to 87.5% in 2017 (14 of 16) for electronic products.

·               The prevalence of combustible or electronic product use or exhaled smoke or vapor increased by quartile of total number of views: 41.9% (8700 to 19 million views) among songs in the first quartile of viewership and 49.7% among songs in the fourth quartile of viewership (112 million to 4 billion views).

 

The researchers concluded that the genre’s broad appeal, use of branded products by influential artists, and rise of electronic product and marijuana use may contribute to a growing public health concern of tobacco and marijuana use.

 

Source: Knutzen et al. (2018). Combustible and Electronic Tobacco and Marijuana Products in Hip-Hop Music Videos, 2013-2017. JAMA Internal Medicine, Oct 15. doi: 10.1001/jamainternmed.2018.4488. [Epub ahead of print]

Did You Know? Tobacco Use Is A Major Cardiovascular Risk Factor For American Indians

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Heart disease is the leading cause of death in American Indians (AIs). A newly published study examined cardiovascular risk factors in Northern Plains American Indians undergoing coronary artery bypass grafting surgery. AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7%) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0%). The researchers concluded that AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use.

Source: Anderson et al. (2018). Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting. Health Equity, Aug 1;2(1):152-160.